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Nelson Mandela is Dying: Three Lessons for You and Your Family by Dr. Monica Williams-Murphy

Dr. Monica Williams-Murphy is a Board Certified Emergency Medicine Physician, who practices in one of the largest emergency departments in the United States at Huntsville Hospital. Through her writing and speaking, she is devoted to transforming the end of life into a time of peace, closure and healing. Media Page

By typical end-of-life definitions, Nelson Mandela is dying (he is in critical condition after a lengthy hospital stay, and has had multiple recent admissions). Those of us in the healthcare professions see this end-of-life equation all of the time: increasing severity of illness and frequency of hospitalizations plus advanced age almost always equals dying. Now, everyone likes to believe this equation may be altered by hopes, prayers, and modern medicine. But unfortunately, such yearnings usually fail to change the equation, no matter how powerful our offerings or how advanced our medicine.

President Mandela is a case in point. A case followed closely by the world, but also foreshadowing what may happen with each of us at the end of our own lives. We can all learn the following three lessons from his end-of-life experience.

Lesson One: Recognize the End-of-Life Equation
On June 9, 2013, South Africa’s best-selling weekly newspaper, The Sunday Times, reported that Mandela’s long-time friend Andrew Mlangeni publicly stated: “You (Mandela) have been coming to the hospital too many times. Quite clearly you are not well and there is a possibility you might not be well again.” Mandela’s long-time comrade recognized and verbalized the end-of-life equation whether the rest of the world wants to hear it or not. I applaud him. Oftentimes, the only one who is willing to acknowledge what is really happening is the one who is approaching death himself. The rest of us: friends, family and even doctors, often choose to remain in a state of denial believing that more can be done to change the equation.

Lesson Two: Understand Decision Motivations
Lots of people want to keep Nelson Mandela alive at all costs, even if it inadvertently causes unnecessary suffering for him. You may read this and ask, “Are these people selfish?” I would say, generally, they are not…we are not. We all love him and recognize his iconic peace-promoting power in South Africa and abroad. However, our perspectives are underpinned by “our” desires for him rather than perhaps asking what he would desire for himself. Virtually the whole world is praying for his return to health. In contrast, Mr. Mlangeni, was also quoted in The Sunday Times article urging Mandela’s family to “release him” and “let him go.” This position is the most selfless and loving, but can also be the hardest to realize. Again, should we become involved in making end-of-life decisions for another, we must ask ourselves about the motivations for our choices. We should select care not based on what we desire or fear about our loved one, but should with great reflection select treatments which the dying would choose for themselves.

Lesson Three: Give Permission to Die
In South African culture, it is customary for the family to give final permission to die, to emotionally and spiritually release the one who is approaching death. At some point Nelson Mandela will receive the words, “We release you, Father.” I have given this same permission to my very own dying grandmother, and I have frequently stood at the patient bedside as families gave permission to their own. Rarely, in living, do we create occasions to bid such sweet offerings to those we love, but surely in the face of dying, we should utter the words, “Thank You,” “I Love You,” and “Good-bye…I release you.”

So, Nelson Mandela is dying (either shortly or in the not so distant future), yet he remains iconic, not only for South Africans, but for the rest of us as well. Take these three lessons from the end of his life and apply them to yourself and your own family. Then take his words and apply them to your life: “What counts in life is not the mere fact that we have lived. It is what difference we have made in the lives of others that will determine the significance of the life we lead.” (“The Top 10 Nelson Mandela Quotes,” The South African)

(Of note, I submitted this to multiple Op Ed Venues and no one was interested in publishing it. I take that to mean either A) the article has no merit B) even media thought leaders are not comfortable publicly discussing death- reflective of our prevailing death-phobic paradigm, or C) people thought it was in poor taste to predict the death of our dear Mandela, or D) All of the above. Regardless, here it is for your review)

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26 thoughts on “Nelson Mandela is Dying: Three Lessons for You and Your Family by Dr. Monica Williams-Murphy”

CREDIT to Dr. Monica Williams-Murphy for publishing this post despite refusal by multiple Op Ed Venues. What I found particularly striking and meaningful about this post resides in how well known the person (Nelson Mandela) is. Learning to recognize “the Equation” takes on new meaning when applied to someone who is personally close to us, or to a well-known personality in world affairs. There is a powerful message here. THANK YOU Dr. Williams-Murphy for writing this!

I totally agree. I work for a hospice agency and far too often the family wants to answer for the patient rather than allowing the patient to answer for themselves what they want. Case in point, many family members refused to sign a DNR. However, when the patient is asked what they want and the DNR is explained to them, the patient wants the DNR and wants to be allowed to die peacefully and in their home. Most patients don’t want to die in the hospital. I find the need for end-of-life education to be one of the greatest needs in our nation. Thank you for your article!

Well done! I have been feeling sad and despondent about how little palliative care has impacted on the world in general as I watch and listen to the statements from Zuma and the Mandela family. I understand the general public believing that they have the power of wish and prayer. But this is a moment for palliative care advocates to work with leaders and influential people to understand this point. That being able to sensitively acknowledge that this man is dying and that he will not recover good health will ultimately help his family, those close to him, South Africans and the world at large. I live and work in Zimbabwe and am passionately involved in palliative care across the continent. This for me is a golden opportunity for palliative care to build upon. I intend doing so in my training and supervision…

I agree.
Like many of us, Nelson Mandela did not have a sugar coated easy life. Still, from a Christian perspective–death can be graceful. “Truly, truly I say to you, unless a grain of wheat falls into the earth and dies, it remains alone; but if it dies, it bears much fruit. He who loves his life loses it, and he who hates his life in this world will keep it to life eternal.” (Words from Jesus Christ,– quote from New American Standard bible @ John, chapter 12, verses 24 & 25.)
Nelson’s energy was not love directed toward his life. It was love directed toward a better life for others. Allowing him to fall to the ground might be similar to allowing a new Rose in God’s Garden.

Together we can make a difference. It is true and right. — Shame on the multiple news outlets for denying the perfect moment for national conversation on end-of-life matters. The “media thought leaders” are humans just like the rest of us and fear death as much as most Americans. In that case, not incidentally, they are NOT “leaders” but merely followers in the parade of death deniers. We would honestly be embarrassed to follow such weak non-leadership. The illusion of immortality seems to remain alive and well here. It is the stuff of an immature, childish mind set which never made the effort to grow up. Perhaps the problem with the article is that it has too much merit? Perhaps it comes too close to the all-American need to repress thoughts of death and dying. FEAR. So common to hear, “Interesting. Sorry about Mandela, but that can’t happen to ME!” Together we can change that. Slow process but necessary. As long as the national conversation is on the way, the media will eventually follow…just out of a profit+political motive if nothing else. Dr. Murphy, you are leading the way. That is real leadership and so very much worth following. You are not alone! Let me join you at the front.

A bit unprofessional to offer a clinical opinion without a) ever having examined the patient, b) seeing their clinical history or c) seeing their medical records. As to the current president urging the family to ‘let him die’…phew! He’s got his own reasons for wanting that….thank heavens he wasnt nominated to be Advance Decision Maker…..

Every time I can I talk to people about allowing natural death and advance directives for dying as well as after death care. Most of the time people are interested because I’m having these conversations one-on-one in a safe environment. No need to sell advertising.
Thank you for taking the opportunity to say all this, over and over, Monica, even though the message gets shunned.
Peace, Nelson.
Merilynne Rush, Home Funeral Advocate and Educator

I take exception to the openly insulting use of the word “unprofessional.” I see no effort to “offer a clinical opinion” here. The author of this article knows only what the rest of the world knows: President Mandela is probably dying. The comment completely misses the point of the article, and the point is not subtle. It is sharply outlined. Recognize that every life ends, do not be a death denier, medical technology has its limits, choose end-of-life care for your loved one based on what HE – not you – would most want, and gracefully allow/permit to happen what would happen anyway: death. These points are important and still rarely accepted in American life. — I think this article furthers the efforts of certain sophisticated health care professionals to make the subject of death and dying less scary and more sane. Advance planning is right in every case. That is a fundamental issue. Letting go the loved one is hard, but it is one of the caregiver’s true final gifts.

I agree with your thoughts. I have just experienced a similar situation with a sick family member where saying goodbye and letting go was difficult for many in the family. We need to openly talk about death and EoL issues in Africa. Quantity and not quality of life seems to be the focus resulting in prolonged suffering. Lets continue the education.

WHO is more qualified than the dying person to make that deicision? I would not want anyone else to decide for me. I think that is our last decision and anyone’s right to make. This is the reason I have an Advanced Directive. No one will make a decision to keep me on machine or feeding tubes. I will direct, even if from paper, when I am to die.

My life-loving mother, on her death bed ,looked at us trying to find alternative therapy and said
” I know you love me ,you don’t need to do this to prove it to yourselves, others , or me. Only because you love me this much you will be able to sacrifice your hope for my return, put your heart through the unbearable, and just hold my hand while I go”

You words are well worth publishing and especially reading and taking to heart. My mom died last Saturday night; I had to face those decissions and put aside well-meaning uninformed opinions. She died very peacefully.

My sympathy, Mark Knister. I’m glad you found Dr. Murphy. She has so much to say about death and dying. She has thought about it at length and deeply. Also, her book is well worth reading. It is excellent, beautifully written, thought-provoking. Try that. It helps. Best to you as you deal with the death of your mother.

We seem to be high fiving ourselves on this blog for having made some points that could have been made without tacking them on to the celebrity of Nelson Mandela. Our language about death and dying often places us in the position of “experts” when there is no roadmap for handling a dying process. From my view dying is an art, science and educational. The degrees of each are unclear and for families who are invested in their loved ones those lessons are rarely learned in real time. Our views are often clinical, professional and absent of the emotion. Perhaps we would be better received if the timing of our words did not collide with the subject’s dying process. The author of this article mentioned four reasons why this publication could not reach some of the intended audiences and she covers them well. So while she makes valid points, the timing of this article turns the “lessons” into a preaching to the choir moment with us shouting “amen”. Nelson Mandela will be remembered for how he lived not how he died. Sometimes it is insulting to make object lessons of a dying Icon when the value of his life is still being cherished by so many.

The lessons from President Mandela’s dying take absolutely NOTHING away from his honorable living! Additionally, the lessons taught here are best learned in a time when so many people are watching the probable end (death) of a treasured life.

I believe President Mandela would approve these lessons and especially this effort to better inform the Everyman. Sanity in the face of insanity was part of the beauty of his life.

This is one of those perfect moments to talk about death and dying, when the whole world is thinking about it. The lessons are good, well thought out, and right for our time. Nothing in these lessons diminishes – even slightly – the esteem in which all of us hold President Mandela or his legacy.

My time working with families with a loved one in hospice care taught me the importance of the importance of their “letting go” of the loved one. It is such a difficult time for all involved, yet, it is likely the most loving act that can be shared. I commend you for shedding light upon a difficult, yet critical, time for those who love and admire Mr. Mandela…and those who will have to face a similar decision in their own families.

Fascinating dialogue around a topic close to the heart of so many. As a chaplain working in the field of hospice for 11 years and as the bereavement counselor who after the death works with the ones left behind, I am no longer astounded by the inability or seeming unwillingness of family members (and entire communities) to recognize, embrace and/or take advantage of the opportunities present when we see that someone’s transition is coming. Each of us doing this work of companioning the dying chips away at the age old cultural morays around death and dying that interfere with peaceful dying in any way we can, one patient at a time, one family at a time, one situation at a time and then we honor the one leaving, the choices they make, the voices they use and the spoken and unspoken needs. And because of the fact that they have shared their journey, those of us privileged enough to companion them on any level can live our own lives differently, thus turning the proverbial “Titanic in the bathtub” just a little at a time by how we ourselves approach our own eventual mortality.

even in his death/dying,nelson is trying to teach us something that unfortunately too many have forgotten. 1) first and for most it is best to have a living will and a health care proxy you trust will follow issues. this person must be selfless-ie. continue to try to tie you to the death bed because of that individual’s fear of death and fear of seeing the one they love die. death has become far to involved in focusing on quantity-not on QUALITY of life. what we have seen across the board with human beings-if they don’t have control or know the outcome(even if it is clear to anyone focused on the on such and may have good intentions-we think in hospital,every last effort must be done. but who is that for-for those who will be left behind. the kindest thing you can do is focus on the individual’s positive life and be ever so grateful for having them in your life. this is their tremendous gift to us. time to give back and honor the individual’s choices not the one who don’t want to be with him/her. my sister is a veterinarian she is continuly frustrated by the fact that beyond all logic or care-people will continue to allow their pet to continue to suffer,despite her efforts to explain what their unwillingless will create-unnecessary suffering.
I worked several years with AIDS,we did make decisions that reducing pain took priority over others unresolved issues that should have been worked out years ago. regret,guilt,fear and the actual thinking that the pt. is the family’s to die. death rests with many circumstances-almost all who come to the one who are dying. a peaceful death with those one loves far outweighs one last chance. that is called magical thinking-ask for this,promise to do x and my loved one will be spared.
the truth is NO one can escape death. as far as suicide I would like to just add that you probably those after all that time-will decide. those who choose to commit suicide do so out of a sense real or created over time that they lack approval,they need to celebrated in life. most important people who are facing death can share with one another what to many fear. those dying and those witnessing know that the passing of souls from one to the next is a sared gift. the gift to the dying of memories,holding a hand,caressing an arm-one last I love you and if lucky a brief moment between both of what is occurring before them. the cycle of life-born,struggle,hopefully a dream filled life-the dream of walking this earth and hopefully sharing with the natural order and nature of a tremendous work of art. there is no one who scaths life wounds untouched. hopefully life/death reminds us of the gift we must share now-every day. the gift of earth,sky,sun.stars. and I will dare to say the greatest gift-the family of our own that we have been able to seek and be with. then we receive what so many of us fail to-look around at friends,other positive people,recognize the gits of nature and every being to have their chance at life as well.

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